Does Medicare Cover Genetic Testing For Cancer?

Are you at risk of developing cancer? It’s a question many think about and are seeking an answer to.

One big risk factor for cancer is genetics. And, thanks to recent scientific advances, genetic testing for cancer is more accurate and widely available than ever.

By understanding your genetic risks for cancer, you can take action to protect yourself. This could involve lifestyle changes to reduce your risk of cancer.

It could also involve more frequent cancer screenings. The goal there would be to catch cancer as early as possible. Because early detection and treatment can help produce more favorable outcomes for those with cancer.

These tests are also helpful for family members who want to understand their risks of developing certain cancers.

With the popularity of genetic testing for cancer increasing, a more common question many have is “Does Medicare cover genetic testing for cancer?”

In this article, we answer that question in clear, plain English. You will also find the average costs of genetic testing for cancer and other helpful info.

Does Medicare Cover Genetic Testing For Cancer?

The short answer is yes; Medicare will cover the cost of genetic testing for cancer. But not 100% of the time. As is often the case with Medicare, certain conditions must be met in order for Medicare to pay for your genetic testing. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for genetic testing for cancer. However, coverage depends on what test you want and whether or not the test is medically necessary.

Here are the scenarios under which Medicare will currently cover some types of genetic testing for cancer…

If you have recurring, relapsed, refractory, metastatic, or advanced stage III or IV cancer
You have cancer and want to undergo further cancer treatments
If you have symptoms of cancer and genetic testing may help in determining and diagnosing cancer
You have not used the same genetic test for the same previous cancer diagnosis
You were diagnosed with breast cancer before you reach the age of 45, or at the age of 45
A history of the epithelial ovarian, fallopian tube, or primary peritoneal cancer
You have two primary breast cancers before you reach the age of 50
Your ethnicity is more prone to having the BRCA mutation, the Ashkenazi Jewish ethnicity for example
A family history of breast or ovarian cancer
There’s a close relative with the BRCA mutation
A male close relative had breast cancer
A first-degree relative with a mutation such as Lynch syndrome

BRCA Testing

Medicare will also cover genetic testing for BRCA1 and BRCA2. It will cover these tests if you have a personal and/or family history of breast cancer. Medicare will also cover tests for hereditary breast, tubal, primary peritoneal and epithelial ovarian cancer as well.

Other Types of Genetic Testing for Cancer

Medicare Part B covers prostate cancer screening for men over the age of 50 every 12 months.

It also provides coverage for Myriad Genetics myPath and Castle Biosciences DecisionDx genetic tests for melanoma.

Once approved, Medicare Part B covers 80 percent of the costs of genetic testing for cancer.

Part C

Medicare Advantage plans (Medicare Part C) also provide coverage for genetic testing for cancer. They cover everything Original Medicare covers as well as offer some additional benefits. However, exactly what it covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan.

How Much Does Genetic Testing For Cancer Cost?

Costs for these genetic tests can vary widely. You can find some that cost under $100 and others that can cost up to $5000 or so. Costs depend on factors including where you get the testing done, the type of test and what cancer(s) you’re testing for.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.